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目的采用荟萃分析方法研究在急性呼吸衰竭(ARF)患者中使用头罩和面罩无创通气的疗效。方法以“helmet,face mask,facial mask”和“mechanical ventilation或noninvasive ventilation”为英文检索词,检索Pub Med、OVID、Embase、Scopus和Cochrane等数据库,并搜索相关网页及参考文献。以“头罩、面罩、机械通气、无创通气”为中文检索词,检索中国知网和万方数据库。检索时间为建库至2016年12月。2名研究人员分别独立评估试验质量和提取信息。采用Revman 5.3对数据进行合并统计分析。结果最终纳入10项随机对照试验(RCTs)和6项病例对照试验。荟萃分析结果显示,与面罩相比,头罩无创通气降低气管插管率(OR=0.35,95%CI为0.24~0.51,P<0.000 01)、住院死亡率(OR=0.51,95%CI为0.34~0.76,P=0.001)、无创通气相关并发症(OR=0.10,95%CI为0.06~0.15,P<0.000 01)。在改善气体交换方面两组间没有显著差异。在亚组分析中,ARF的类型和通气模式不影响插管率和无创通气相关并发症,头罩无创通气主要降低低氧血症性ARF或压力支持通气患者的住院死亡率。结论头罩无创通气可以降低ARF患者的插管率、住院死亡率和无创通气相关并发症。头罩在改善患者气体交换方面与面罩同样有效。然而,未来仍需要更多的随机对照试验来进一步确定头罩无创通气的作用。
Objective To investigate the efficacy of noninvasive ventilation with headgear and masks in patients with acute respiratory failure (ARF) using meta-analysis. Methods The search terms were “helmet, face mask, facial mask” and “mechanical ventilation” or “noninvasive ventilation”. The databases of Pub Med, OVID, Embase, Scopus and Cochrane were searched and the related web pages and references were searched. To “hood, mask, mechanical ventilation, noninvasive ventilation ” as the Chinese search terms, search CNKI and Wanfang database. Search time for the construction of the library until December 2016. Two researchers independently assessed the quality of the trial and extracted the information. Revman 5.3 was used to conduct a statistical analysis of the data. Results Ten randomized controlled trials (RCTs) and six case-control trials were finally included. Meta-analysis showed that noninvasive ventilation reduced the endotracheal intubation rate compared with the mask (OR = 0.35, 95% CI 0.24-0.51, P <0.000 01) and hospital mortality (OR 0.51, 95% CI 0.34-0.76, P = 0.001). Noninvasive ventilation related complications (OR = 0.10, 95% CI 0.06-0.15, P <0.000 01). There was no significant difference between the two groups in improving gas exchange. In a subgroup analysis, ARF type and ventilation patterns did not affect intubation rates and complications associated with noninvasive ventilation. Noninvasive ventilation of hoods primarily reduced in-hospital mortality in patients with hypoxemic ARF or pressure support ventilation. Conclusions Noninvasive ventilation of the hood reduces the intubation rate, in-hospital mortality and complications associated with noninvasive ventilation in patients with ARF. Headgear is as effective as a mask in improving patient gas exchange. However, more randomized controlled trials are still needed in the future to further determine the role of noninvasive ventilation of the hood.